Provider First Line Business Practice Location Address:
1413 W YORK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99205-3568
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-951-0995
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/19/2020